‘Undetectable’ a new identity for gay men diagnosed with HIV

Achieving an undetectable viral load is a key milestone in the period after diagnosis with HIV, qualitative interviews with Canadian gay men suggest. Men incorporated knowledge of their own undetectable status into their identities as HIV-positive gay men and their sexual decision making, according to a study published in the August issue of AIDS Education and Prevention. Being undetectable helped many men feel ‘responsible’ and ‘normal’.

The findings come from in-depth, qualitative interviews with 25 gay men diagnosed with HIV in British Columbia, Canada between 2009 and 2012. All had acquired HIV less than a year before their diagnosis and half had been diagnosed with acute (very recent) infection. Up to four interviews were done, in order to see how experiences changed during the year after diagnosis.

Interviewees typically reported a period of sexual abstinence immediately after being diagnosed with HIV. During this period of adjustment, many men had no sex drive. Avoiding HIV transmission was a major concern for many, including this man:

“First of all, I killed my sex life. I was like, you know, I don’t want to infect anyone, I don’t want to take the risk and I don’t want to disclose, so the way of not doing is just not having sex.”

When participants did start to have sex again, they found themselves in an altered sexual landscape, facing new scenarios, challenges and possibilities. Faced with the difficulty of talking about having HIV with new partners, some sought out other HIV-positive men. Others avoided anal sex, even with condoms.

Learning that one’s viral load was undetectable could open up new possibilities:

“I didn’t play around when I was not sure… if I was undetectable or not. I didn’t play. They [sexual partners] would be open to it, but I didn’t want… Personally I didn’t feel comfortable, so I didn’t play until I was undetectable.”